BACKGROUND: Extended-spectrum beta-lactamase-producing (ESBL) Klebsiella pneumoniae is an important cause of nosocomial infections in neonatal intensive care units (NICUs). This study aimed to reduce ESBL-producing K. pneumoniae in the NICU by using infection control measures. METHODS: We performed prospective surveillance cultures, monitoring, and education for infection control in the NICU between May and August 2011. Specimens were collected from all infants and the environment including stethoscopes, thermometers, ventilators, incubators, etc. The anterior nares and hands of healthcare workers were also screened. We inspected infection control practices and provided feedback. The level of infection control awareness was measured using a questionnaire. RESULTS: The level of awareness and performance of hand washing increased significantly after intervention (both P<0.001). The environmental management of healthcare providers also improved significantly (P=0.001). The yield of ESBL-producing K. pneumoniae from clinical specimens decreased gradually throughout the study period (30.4% in May to 12.6% in August). Central catheter-related K. pneumoniae bacteremia decreased from 1.3/1000 to 0/1000 catheter-days. CONCLUSION: Infection control measures including education, monitoring, and surveillance can lower the incidence of ESBL-producing K. pneumoniae in the NICU.
Bacteremia ; beta-Lactamases ; Cross Infection ; Delivery of Health Care ; Hand ; Hand Disinfection ; Health Personnel ; Humans ; Incidence ; Incubators ; Infant ; Infant, Newborn ; Infection Control ; Intensive Care Units ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Klebsiella ; Klebsiella pneumoniae ; Pneumonia ; Prospective Studies ; Stethoscopes ; Thermometers ; Ventilators, Mechanical

The purpose of the study was to determine the effects of the 8-week, 15-session group art therapy program on self-esteem and mental health status in chronic schizophrenic inpatients. The sample consisted of two groups of chronic schizophrenic inpatients: 10 patients with an average of total disease duration of 8.90 years who participated in a 8-week group art therapy program, and 8 comparison subjects with an average of total disease duration of 8.25 years who did not participate in the program. A pretest-posttest quasiexperimental design was used to assess self-esteem and mental health status at the beginning and at the end of the 8-week, 15-session group art therapy program. The time points for obtaining data were matched for both groups. The effectiveness of the 8-week group art therapy program was assessed by Rosenberg's Self-esteem Scale(Rosenberg, 1965) and SCL-90- R(Derogatis et al., 1973). SPSSWIN 8.0 was utilized for data entry and analysis employing Mann-Whitney U test. The findings of the study indicated the followings: (a) No significant differences were found between two groups in self-esteem and (b) The experimental group showed significantly lower scores in obsessive-compulsive symptom dimension and interpersonal sensitivity symptom dimension on the SCL-90-R than the comparison group after participating in the group art therapy program. In conclusion, the findings showed the possibility of applying group art therapy as an effective nursing intervention for patients with lack of verbal communication skills and social interaction to improve their interpersonal relationship.
Art Therapy* ; Humans ; Inpatients* ; Interpersonal Relations ; Mental Health* ; Nursing

With a ordinary goniometer, we measured the range of active motion of the wrist flexion, extension, ulnar and radial deviation in 120 normal adult subjects ranging in age from 20 to 49 years old. Normal limits were determined for the male and female groups, for the age groups, and for the right and left sides, respectively. The data were compared with the axial angles in roentgenograms that described by T.E. Keats in 1966. And we have undertaken a study of the correlation between the range of motion and the axial angles. The results were as following: 1. Range of active motion (degrees±standard deviation) Rexion; 73.9 ±6.386. extension; 65.9 ±5.164 unlar deviation; 28.3 ±5.124 radial deviation; 18.6±2.556 2. Axial angles (degrees±standard deviation) P-A view;73.8±3.985 lateral view;79.7±4.777 3. Males had a smaller range of motion than female in wrist joint. 4. The right side showed a smaller range of motion than the left. 5. There were no correlations between the range of motion and the axial angles.
Adult ; Female ; Humans ; Male ; Range of Motion, Articular ; Wrist Joint ; Wrist

Guyons canal syndrome is an uncommon disease characterized by ulnar nerve compression symptoms within Cuyon s canal. The symptoms vary with the level of compression, and the cause of compression may be extrinsic or intrinsic. We have had experience with a case of the syndrome that was caused by a ganglion in the canal.
Ganglion Cysts ; Ulnar Nerve Compression Syndromes

The authors report their experiences of direct intracranial operation on 2 cases of ruptured giant middle cerebral artery aneurysm which have similar diameter size (over 2.5cm) and location (middle cerebral artery bifurcation area). On had showed subarachnoid hemorrhage at the right sylvian fissure and another had showed was operated 25 days after ictus because of generalized seizure attack and vasospasm on cerebral angiography, the latter was operated within 18 hours after ictus due to semicomatose mental state and intracerebral hematoma on the right temporal lobe. We have utilized on giant aneurysmal surgery with multiple tactics such as transient hypotension, temporary clipping, multiple clipping, puncture or incision of the aneurysmal body and removing of hematoma.
Aneurysm ; Cerebral Angiography ; Cerebral Arteries ; Hematoma ; Hypotension ; Intracranial Aneurysm ; Middle Cerebral Artery* ; Punctures ; Seizures ; Subarachnoid Hemorrhage ; Temporal Lobe

Overexpression of the MDR1 gene product, P-glycoprotein (Pgp), has been shown to be one of the mechanism underlying the development of mutidrug resistance in bladder cancer. Recently, mutant p53 has been shown to stimulate the P-glycoprotein and to being strongly associated with tumor progression and malignant biological behavior, whereas wild-type p53 repressed this activity. To evaluate the correlation of p53 expression with P-glycoprotein, to study expression pattern of two parameters according to histologic grade, tumor stage and recurrence, we examined expression of p53 and Pgp in paraffin-embedded tissues from 59 transitional cell carcinoma of bladder. Expressions of p53 and Pgp Protein were detected by immunohistochemical analysis using the monoclonal antibody BP53.12 and JSB-1. Among the cases of 59 patients, 36 were from patients of superficial bladder cancer, 23 were from invasive bladder cancer. Median follow-up duration was 31.8 months (1~55 months). The results were as follow: 1. p53 was detected in 34% (20/59), and Pgp in 42% (25/59) of the bladder cancer. 2. Eight out of the 20 specimens with p53 positive stain expressed positive Pgp expression, as compared to 17 out of the 39 specimens without p53 positive stain. This result showed that Pgp expression was not associated with p53 expression (p=0.98), suggesting that mutant p53 does not induce Pgp expression in bladder cancer. 3. Seven of 12 patients with p53 positive stain revealed tumor recurrence, whereas 2 of 24 patients without p53 positive stain showed recurrence in superficial bladder cancer. There ia s significant correlation between p53 expression and recurrence (p=0.0025). 4. Expression of p53 and Pgp showed enhanced positive tendency according to higher clinicopathological stage, but difference was not statistically significant. Also positivity of Pgp expression according to histologic grade was observed significantly higher in case with high grade tumors (14/25, 56%) than in case with low grade tumors (10/34, 29%) (p=0.03). These results show that superficial bladder cancers exhibiting expression of p53 protein are associated with a higher rate of recurrence. This study also suggests that Pgp expression is significantly more common in higher grade, and mutant p53 does not induce Pgp expression in bladder cancer.
Carcinoma, Transitional Cell ; Follow-Up Studies ; Humans ; P-Glycoprotein* ; Recurrence ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Left ventricular false tendon, also called moderator bands, anomalous cords, accessory bands or false chordae tendinae, has been known as simple anatomical without clinical importance. But the possible relationship with Still's type murmur and ventricular arrhythmia were reported recently. The incidence of false tendon was known as 0.5-6.1% variably. In Korea, there are no reports about left ventricular false tendon till now. The authors examined 2,052 patients' echocaediograms and clinical manifestations retrospectively to find the incidence and potent clinical significance of false tendons. The incidence in present study was 1.02% and there was no specific relationship between false tendon and cardiovascular diseases. The authors observed Still's type musical murmur in 5 patients out of 21 and ventricular premature beats in 2 patients out of 10 without other cardiovascular diseases. One of them showed nonsustained ventricular tachycaedia during Holter ECG monitoring. The most frequent echocardiographic site of attachment was from basal inter-ventricular septum to lelft ventricular free wall and false tendon attached to papillary muscle was least frequently observed.
Arrhythmias, Cardiac ; Cardiac Complexes, Premature ; Cardiovascular Diseases ; Echocardiography ; Electrocardiography ; Humans ; Incidence ; Korea ; Music ; Papillary Muscles ; Retrospective Studies ; Tendons*

Identification of patients with combined valvular prolapse has important clinical imlications, because such patients appear to be early surgical candidates. Detection of combined valvular prolapse became more feasible with development of 2-dimentional echocardiography and the incidence of combained mitral and valve prolapse is reported to be variable from 3% to 24%. The authors found a case of combined mitral and aortic valve prolapse detected by 2-dimensional echocardiography. This 30-years-old male patient who admitted because of peptic ulcer bleeding revealed a prolapse of anterior mitral leaflet with regurgitation and also a prolapse of the right coronary cusp into the left ventricular outflow tract but without evidence of aortic regurgutation by Doppler echocardiogram. he discharged without surgical intervention and needs further observation.
Aortic Valve Prolapse* ; Aortic Valve* ; Echocardiography ; Hemorrhage ; Humans ; Incidence ; Male ; Mitral Valve ; Peptic Ulcer ; Prolapse

BACKGROUND: In order to investigate the efficacy and safety of cilazapril, a recently developed angiotensin converting enzyme inhibitor, a clinical study was performed in the patients with mild to moderate essential hypertension. METHODS: The study subject consisted of 31 patients with diastolic blood pressure of 95mmHg~115mmHg (mean age : 56.0+/-8.1 years, 16 males and 15 females). Cilazapril was administered orally in a daily dose of 2.5mg~5.0mg Q.D. for 8 weeks. During cilazapril medication, anti-hypertensive efficacy, side effects and laboratory changes were monitored. RESULTS: Cilazapril decreased blood pressure from baseline value of 162.2+/-4.7/98.4+/-2.8mmHg to 144.6+/-10.0/89.7+/-5.7mmHg after 4weeks of medication (p<0.05) and 138.2+/-4.5/87.8+/-4.0mmHg after 8 weeks of medication (p<0.05). Heart rate change was not significant (72.3+/-4.7/min vs 71.7+/-3.6/min). Body weight change was not significant (66.6+/-9.8 Kg vs 66.8+/-9.9 Kg). There were no significant change in blood chemistry and hematologic examination except mild elevation of alanine transaminase and serum creatinine values but these date were within normal ranges. The side effects were dry cough (4 case, 12.9%), headache (2 case, 6.4%), indigestion (1 case, 3.2%) and dry mouth (1 case, 3.2%). One patient dropped out due to severe dry cough but others were mostly mild in nature. CONCLUSIONS: Cliazapril 2.5mg~5.0mg once daily regimen was effective and well tolerated in patients with mild to moderate essential hypertension.
Alanine Transaminase ; Blood Pressure ; Body Weight Changes ; Chemistry ; Cilazapril* ; Cough ; Creatinine ; Dyspepsia ; Headache ; Heart Rate ; Humans ; Hypertension* ; Male ; Mouth ; Peptidyl-Dipeptidase A ; Reference Values

The authors reviewed forty cases of acoustic neurinomas operated on from July 1974 to June 1984, analyzing our data obtained during 10 years in the following three periods: 1974 to 1978, 1978 to 1981, 1981 to 1984. A suboccipital approach was used for the removal of acoustic neurinomas in all cases. 1) A peak in the age distribution was seen at 40-50 years of age and no sexual difference was present. 2) The earliest symptoms were hearing loss(50%), headaches(25%), tinnitus(15%) in order of frequency. The time between onset of complaints and admission was mostly within 5 years(83%). 3) Most of the patients had large tumors(78%), greater than 3cm, of whom 4 patients were free of cerebellar and brain stem dysfunction. 4) Total removal was carried out in 27 out of 40 patients(67%) and particularly in 8 out of 14 patients(57%) with large tumors greater than 5cm. The total mortality was 7.5%. 5) In the last 3 years with the advance of microsurgical technique and CT scan, 25 patients were operated on only with a single death and total removal was carried out in 20 out of 25 patients. 6) In total removal, the total mortality was 7.4% and the mortality was 8% in patients with 3-5cm sized tumors and 13% in patients with tumors greater than 5cm, particularly 5% in the recent 3 years. 7) Preservation of the facial nerve following total removal was achieved in 59%. In the recent 3 years, the facial nerve was preserved in 65%. In the large tumors, 3-5cm sized and greater than 5cm, the rates of 75% and 37% were obtained.
Acoustics* ; Age Distribution ; Brain Stem ; Facial Nerve ; Hearing ; Humans ; Mortality ; Neuroma, Acoustic* ; Tomography, X-Ray Computed